Many individuals who survive a stroke with neuromuscular deficits eventually
experience some type of spasticity. Spasticityanswers.com defines spasticity as
a neuromuscular condition in which
muscles contract and spasm, causing stiffness and pain.

Spasticity is the result of a disorder or damage involving the central nervous
system—brain and spinal cord. The exact cause of the condition has yet to be
determined so consequently researchers are having difficulty finding a cure.

Some research suggests that the loss of control over the muscle from primary
motor cortex in the brain results in hyperactivity in the neuromuscular
connection, the junction between the nerve and the muscle it controls. The motor
neuron that controls contraction of the muscle begins to secrete constant high
levels of neurotransmitter causing the muscle to go into a state of constant
uncontrolled contraction.

Those suffering from this condition are often seen to carry their hands in a
fist with their arms held high against their chest. The condition also results
in foot drop where the ankle and toes are seen to bend inward causing inability
to balance and develop a proper walking gait.

The condition often develops over time and may not fully manifest itself until
several weeks or months following the stroke. In my case it was the condition
was not identified until almost 10 weeks after the stroke. When I initially was
treated for left side hemiplegia (paralysis) my arm and leg were totally flaccid
with no muscle tone at all.

Over time the spasticity caused my hand to curl into a fist and my foot to bend
inward. My therapist initially advised that an AFO for my left leg would help to
straighten my leg and allow me to balance as I attempted to walk. This plastic
brace was able to hold my leg in a more natural position but did not relieve the
constant muscle contraction. I began to explore other treatment options.

In consultations with my neurologist and my own research I became aware of a
number of treatments that are available for this condition. The first is
physical and occupational therapy in order to regain some type of controlled
movement in the joint. When voluntary movement is not possible a number of other
options exist.

They include Oral Medication, Injected Medication, Intrathecal Medication and
Surgical Treatments. Exercise is also important.

Oral medications
block the actions of the neurotransmitters in the body in an attempt to lessen
their effect on the muscles. They are commonly known as muscle relaxers. They
have proven to be effective for many patients. The major drawback is that these
medications cannot target specific muscles but effectively relax all the muscles
in the body regardless if they were affected by the stroke.

The effect is that they produce muscle weakness in the entire body and often
cause significant fatigue for the patient. Tinzanadine (Zanaflex) is a common
oral medication. The patient generally goes through an introductory period where
he/she tries various doses to get the best balance between relief of spasticity
and the fatigue that the drug causes. In some cases Zanaflex can be paired with
Provigil (an alertness agent) to help combat the fatigue.

Injected medications
are administered directly into the effected muscle to alleviate the spasticity.
Botox is the most commonly used injectable. It is more effective than the oral
meds and it is muscle specific. The drawbacks are that it must be administered
by a doctor, it is expensive and the effects wear off over time, usually several
months. Repeated treatments are required.

Intrathecal Medications
are administered directly to the central nervous system through the spinal fluid
via a pump that is implanted in the abdomen. The pump administers a constant
dose of the medication. While effective, the drawbacks are that it requires
surgical implantation of the pump and the risks associated with that surgery.

Like the orally administered drugs it cannot target specific muscles but
produces a general muscle relaxation and fatigue through the entire body.

Surgical Treatments
are the most radical of the treatment options. This involves surgical
modification of the joint or tendons that attachs the spastic muscle to that
joint. This is normally reserved for only the most severe cases of spasticity.
In some cases the tendons are lengthened or cut to reduce muscle tension and
loosen the joint. Some new experimental surgeries attempt reroute the tendon
through the bones in the joint to reduce tension.

Since we all know that each patient and each stroke is different, it is
important to find a neurologist or physiatrist experienced in rehab medicine to
prescribe an appropriate plan of treatment for this condition.

In all spasticity cases it is vitally important to regularly stretch the muscles
and move the joint in order to prevent the formation of plaques within the
joint. Plaque buildup in the joint will eventually freeze the joint in one
position, a condition that is difficult or impossible to treat.

Exercise. Joint exercise, either through voluntary muscle movement or
external manipulation by the patient or caregiver will help prevent pain and
eventual freezing of the joint which has plagued so many stroke survivors in
years past. If you are currently in therapy ask your therapist for exercises. A
web search will also give you some instruction.